CMS Manual System - Louisiana Department of Health and Hospitals

dry mouth, and diseases of the oropharynx and esophagus. Swallowing ability may
fluctuate from day to day or over time. In some individuals, aspiration pneumonia can
complicate swallowing abnormalities. 10
NOTE: Swallowing studies are not always required in order to assess eating and
swallowing; however, when they are indicated, it is essential to interpret
any such tests in the proper context. A clinical evaluation of swallowing
may be used to evaluate average daily oral function. 11
Functional ability - The ability to eat independently may be helped by addressing factors
that impair function or by providing appropriate individual assistance, supervision, or
assistive devices. Conditions affecting functional ability to eat and drink include
impaired upper extremity motor coordination and strength or reduced range of motion
(any of which may be hampered by stroke, Parkinson‘s disease, multiple sclerosis,
tardive dyskinesia, or other neuromuscular disorders or by sensory limitations (e.g.,
blindness)). Cognitive impairment may also affect a resident‘s ability to use a fork, or to
eat, chew, and swallow effectively.
Medications - Medications and nutritional supplements may affect, or be affected by, the
intake or utilization of nutrients (e.g., liquid phenytoin taken with tube feedings or
grapefruit juice taken with some antihyperlipidemics). 12 Medications from almost every
pharmaceutical class can affect nutritional status, directly or indirectly; for example, by
causing or exacerbating anorexia, lethargy, confusion, nausea, constipation, impairing
taste, or altering gastrointestinal function. Inhaled or ingested medications can affect
food intake by causing pharyngitis, dry mouth, esophagitis, or gastritis. To the extent
possible, consideration of medication/nutrient interactions and adverse consequences
should be individualized.
Goals and prognosis - Goals and prognosis refer to a resident‘s projected personal and
clinical outcomes. These are influenced by the resident‘s preferences (e.g., willingness to
participate in weight management interventions or desire for nutritional support at endof-life),
anticipated course of a resident‘s overall condition and progression of a disease
(e.g., end-stage, terminal, or other irreversible conditions affecting food intake,
nutritional status, and weight goals), and by the resident‘s willingness and capacity to
permit additional diagnostic testing, monitoring and treatment.
Laboratory/Diagnostic Evaluation
Laboratory tests are sometimes useful to help identify underlying causes of impaired
nutrition or when the clinical assessment alone is not enough to define someone‘s
nutritional status.
Abnormal laboratory values may, but do not necessarily, imply that treatable clinical
problems exist or that interventions are needed. Confirmation is generally desirable
through additional clinical evaluation and evidence such as food intake, underlying
medical condition, etc. 13 For example, serum albumin may help establish prognosis but is
only sometimes helpful in identifying impaired nutrition or guiding interventions. Serum
albumin may drop significantly during an acute illness for reasons unrelated to nutrition;